Preventive Medicine

Background/ImportanceBalancing work and family life is a particular challenge for physicians, yet finding a good balance is crucial given that childcare responsibilities and institutional support strongly influence career trajectories. This study examined female fertility and gender differences in family founding, working hours and childcare responsibilities among physicians in Switzerland. ObjectiveCharacterize fertility and family-founding among women physicians, compare womens and mens family-founding attitudes, and examine how work patterns, caregiving responsibilities and perceived institutional support relate to reproductive outcomes. Design, Setting, and ParticipantsSecondary analysis of an existing, anonymous, cross-sectional, web-based survey of the Swiss internal medicine workforce (fielded from December 2021 to April 2022). Main Outcomes and MeasuresDesire to have children, past or current intent to delay childbearing, self-reported female infertility, number of children, maternal age at first birth, perceived adequacy of external childcare, and employer respect of pregnancy-related working-hour limits. Group comparisons used Welchs t-tests and chi-square tests, and associations with workload used linear regression models. ResultsThis analysis included 682 physicians, 278 (41%) men and 404 (59%) women. Mens age was 39{+/-}12 years (mean {+/-} standard deviation [SD]), and womens age was 36{+/-}10 years. The prevalence of self-reported infertility among female physicians was 27.7%, which exceeds Swiss general population estimates of 10-15% (p<0.001). The mean age at first birth among physician-mothers was 31.3 years, which did not differ from the Swiss average (p=0.388). Women physicians had fewer children than men physicians (p=0.006). Among physicians without children, more women (69.8%) than men (51.6%) currently postponed having children (p<0.001). Also, among parents more women (42.2%) than men (21.8%) had delayed having children (p<0.001). Overall, satisfaction with childcare was limited, with 37% of men and 30% of women rating their childcare situation as inadequate. Among women who had ever been pregnant during employment (n = 123), 57% reported that legally prescribed pregnancy-related working-hour limits were not respected. Conclusions and RelevanceIn this national physician sample, women reported having fewer children and more frequently postponing having children than men, and experienced a higher prevalence of self-reported infertility than the Swiss population. Perceived childcare adequacy was suboptimal for both genders, and many reported insufficient adherences to pregnancy-related working-hour protections. Improving scheduling, enforcing maternity protections, increasing access to reliable childcare, and promoting equitable caregiving norms could enhance reproductive and professional outcomes for women in medicine in Switzerland.

Cervical cancer is one of the top three cancers diagnosed in women globally. When women have access to a testing programme, abnormal cells can be detected to prevent the development of cancer. Research to date indicates that social and cultural barriers are the top two barriers in accessing cervical screening. In Ireland there may be a lack of trust in the National Cervical Screening programme due to previous mishandling of tests, and media coverage of the impacts of inaccurate screening results in Ireland. To understand impact of the health scandal on womens trust in cervical screening in Ireland, nine Irish women ages between 25-65 were interviewed. Data was thematically analysed using a feminist perspective to centre the womens voices in making sense of their appraisal and engagement with services. The data analysis resulted in four themes: Personal Reflections on Systemic Failure; Collective Concern and Blame; Decision Making Influencers and Rebuilding Knowledge and Trust. This analysis conveys distrust in the Irish Cervical Screening programme, feelings of anger, and a sense of neglect from the services. Irish women now place their trust in each other, the experience of their friends, families, their local GP. We discuss these finding to explore how Irish women have reinterpreted the narrative over the screening test in Ireland, and the potential to decrease concern around the topic by incorporating this experience into official narratives. This scandal heightened existing distrust and concern for the quality of womens screening services, and therefore has global relevance which can be applied to screening services more generally.

BackgroundSquamous cell carcinoma of the anus (SCCA) annual incidence among sexual minority men (SMM) with and without HIV is 85/100,000 and 19/100,000 persons, respectively, which is significantly higher than the overall incidence (2/100,000). Since SCCA tumours average [&ge;]30 mm at diagnosis, we assessed the accuracy of individuals to self-detect anal abnormalities. MethodsThe study enrolled 714 SMM and transgender women (SMM/TW), aged 25 to 81 years, in Chicago, Illinois and Houston, Texas during 2020-2022. Individuals were taught the anal self- and companion examinations (ASE/ACE). Then, a clinician performed a digital anal rectal examination (DARE) before participants conducted the ASE or ACE. Accuracy was measured along with factors associated with ASE/ACE and DARE concordance. FindingsThe median age was 40 years (interquartile range, 32-54), 36.8% were living with HIV, and 47.0%, 23.4%, and 23.0% were non-Hispanic white, non-Hispanic Black, and Hispanic. Clinicians detected 245 individuals with abnormalities (median diameter 3 mm). Sensitivity and specificity of the ASE/ACE was 59.6% (95%CI 53.5-65.7%) and 80.2% (95%CI 76.6-83.8%), respectively. Overall concordance was 0.73 (95% CI 0.70-0.76) between ASE/ACE and DARE and increased with increasing anal canal lesion size (p=0.02). However, concordance was lower for participants aged [&ge;]55 years (compared to 25-34 years) and when the ASE/ACE trainer was a lay person rather than a clinician. InterpretationSMM/TW who complete an ASE or ACE are likely to detect SCCA at an early stage when malignant lesions are much smaller than the current median dimension at presentation of [&ge;]30 mm. FundingNational Cancer Institute Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWhile squamous cell carcinoma of the anus (SCCA) incidence is substantially elevated in people with HIV, there are currently no consensus recommendations on how to screen for it, nor is there widespread technological infrastructure for one prevailing method, high-resolution anoscopy. In the absence of screening programs, the size of SCCA tumours at diagnosis are > 30 mm. We searched PubMed for articles between January 1, 2000 and June 15, 2023 using the search terms anus neoplasm and self-examination. We found no studies assessing the accuracy of self-examinations to detect anal masses other than our prior feasibility study. Added value of this studyThe primary goal of the Prevent Anal Cancer Palpation Study was to assess the accuracy of lay self-examinations and companion examinations to recognise abnormalities in the anal region. Clinicians conducted a digital anal rectal examination and recorded all lesions observed at the perianus or anal canal. The median size of lesions was 3 mm. Participants conducted lay examinations and these results were judged against a clinicians examination. The sensitivity and specificity of the lay examinations, for any lesion at the anal canal or perianal region was 59.6% and 80.1%, respectively. As lesions increased in size, concordance increased between clinicians exam and the lay exam. Implications of all the available evidenceIt is now known that high-resolution anoscopy can reduce the risk for SCCA but the infrastructure using this technology is very limited in high-resource settings and almost non-existent in low resource settings, especially where HIV prevalence is highest. The evidence suggests that self- and partner examination of the anal region is feasible and that lay persons can detect lesions that are much smaller than the prevailing size of SCCA tumours.

In 2015, mifepristone, the international gold standard for medical abortion, was approved for use in Canada. Our content analysis of Canadian newspaper coverage describes arguments in favor or against medical abortion and the evolving regulatory framework for mifepristone from six months before approval until the last province included the medication as a publicly insured health benefit (2015-2019). Our study found an exceptionally high level of support for the approval, introduction and removal of regulatory barriers to mifepristone for medical abortion. Of 402 articles, 67% were pro-medical abortion, 25% presented balanced or neutral coverage and only 8% presented solely anti-medical abortion viewpoints. Of the 761 stakeholders cited, more than 90% made positive or neutral statements about medical abortion. Most articles discussed medical abortion as a health issue and contained arguments about how liberalization of the regulatory framework and public payment for mifepristone would improve abortion availability (68%), accessibility (87%), acceptability (34%) and quality (19%). Mifepristones introduction in Canada was presented in newspapers as a way to increase womens health, specifically in rural areas where disparities in abortion access exist. Rather than formal balance, which presents contrasting arguments as equally valid even when the scientific evidence for one vastly outweighs the other, our study identified evidentiary balance where coverage aligned with the majority of evidence and expert opinion. Our results differ from analyses in other high-income countries (United Kingdom, United States) that have found that media frame abortion as a stigmatized and controversial issue or mention abortion predominantly with respect to electoral politics rather than as a health issue. The Canadian print media presented overwhelmingly favorable arguments towards the expansion of mifepristone medical abortion and served to destigmatize abortion by framing the introduction and universal coverage of medical abortion as fulfilling core components of the right to health.

BackgroundErectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED are amenable to treatment using lifestyle medicine approaches with or without pharmacotherapy. AimInvestigate the use and perceived effectiveness of lifestyle medicine approaches to tackle ED. MethodsA cross-sectional online survey of 1177 community dwelling adults explored the prevalence and methods used to tackle ED in the community setting. We examined differences between participants with and without ED. Variables associated with ED in univariable analyses were included in a multivariable logistic regression to identify variables independently associated with the condition. OutcomesSelf-reported measure; perceived effectiveness of lifestyle medicine interventions to tackle ED ResultsMost respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, hypercholesterolaemia and obesity. Medication was the most common management strategy overall (65.9%), followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) did not use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferers received a mental health assessment and 29.2% received other tests (e.g., blood test, medical imaging) by GPs. Cardiovascular training was identified as the best rated strategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity (32.6%) were also positively rated. Clinical implicationsStructured education to general practitioners and community dwelling adults about the impact of lifestyle behaviour modification and how this could influence the appearance or trajectory of ED could help improve personal choice when tackling ED. Strengths and LimitationsTo our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. The principal limitation was the lack of follow-up, and not recording other information including lifestyle factors such as nutrition, smoking, and the use of alcohol and recreational drugs, which may have enabled a fuller exploration of the factors that could influence the primary outcome measures examined. ConclusionDespite the high prevalence of ED, there is not enough awareness in the community setting about effective and low-cost lifestyle medicine strategies, including cardiovascular training and the use of supplements and weight training, to help tackle this common condition

Background and aimThe pornography consuming is increasing through the availability of the internet worldwide and the availability of the pornographic sites without any restriction, pornographic sites have many complications in the consumer and lacking survey in our country which make sense to conduct this study. This study aimed to measure the prevalence of pornography watching among high school students and factors associated with pornography viewing. Materials and MethodsThis cross-sectional study was conducted at Zakho independent administration, Kurdistan Region, Iraq among 5 different high school students and 2 institutions. This survey was conducted using a paper questionnaire administered to the participants between April and July 2022. Chi-square analysis was performed to identify possible risk factors for viewing porn and results were expressed as a p value ResultsTotal number of the participants included in this study was 921 with an average age {+/-} standard deviation (SD) of 16.78 years {+/-}1.26. More than half of participants was male (54.83%), viewed pornography alone (49.08%) and about 69.71% disagree on watching porn. There were statistically significant differences (p <0.001) in the attitude and practice of men compared with women throughout all tested variables. About 50.71% of the participants were viewed pornography at least once in a lifetime, among those 65.1% are male and 34.9% of them are female and 92.55% of participants agree to close pornography sites ConclusionThe prevalence of pornography among high school students is high. Young age, and male gender are predictors for higher pornography viewing and should be considered when designing public health intervention in a related context. Longitudinal studies for investigating pornography consumption among different educational levels are needed to assess the causal relationship between pornography consumption and associated factors.

ObjectiveTo examine the workforce that provides vasectomies in the United States using national-level medical claims data (IQVIA Dx, 2019). MethodsWe combined IQVIA Dx 2019 data on medical claims with information on clinician characteristics and clinician type from the National Plan and Provider Enumeration System (NPPES) and the American Medical Association (AMA) Masterfile. We assessed state-level trends in vasectomy provision. We used multivariate regressions to evaluate the association between clinician characteristics and two outcomes: providing at least one vasectomy and total volume of vasectomies in 2019. ResultsWe found total of 147,618 vasectomies performed by 7,592 clinicians in the IQVIA Dx 2019 data. About 76% clinicians were urologists, 16% family medicine specialists, and about 8% were general surgeons. Urologists performed about 91% of all vasectomies. Overall, about 92% of clinicians were located in urban areas. Multivariate regression analysis showed that clinicians that were female (Odds Ratio (OR) 0.12, 95% Confidence Interval (95% CI) (0.09 - 0.15)), graduated from osteopathic schools (OR 0.77, 95% CI (0.60 - 0.98)) had lower odds of providing vasectomies. ConclusionsClinicians from multiple specialties performed vasectomies in the U.S. Most often, this procedure was performed by male urologists practicing in urban areas. Wide state-level variations exist in vasectomy provision. Clinicians gender, location and type of medical degree received were associated with their vasectomy provision.

Health care providers (HCPs) have an important role in screening for alcohol use across the lifespan, particularly during the childbearing years, and providing brief intervention to yield optimal outcomes and prevent the potential teratogenic effects of prenatal alcohol exposure. ObjectiveThe purpose of this study was to describe the current alcohol screening practices of Canadian HCPs who care for pregnant women and women of childbearing age. MethodsAn online survey was administered in 2017 with the aim to identify current knowledge, attitudes, practices and beliefs among Canadian HCPs on screening, brief intervention and referral to treatment (SBIRT) for alcohol use for this population. The bilingual survey was disseminated by 4 national professional associations. A total of 634 interprofessional clinicians completed to the survey. Descriptive analysis was completed for the respondents profession and their practices related to alcohol SBIRT. Cross-tabulation analyses explored the use of different screening questionnaires. ResultsMost respondents reported asking about alcohol use; however, there was a low overall use of screening questionnaires for both women of childbearing age and those who are pregnant. Low screening rates may equate to missed opportunities for intervention. Low rates of brief intervention and referral were noted even in circumstances where at-risk drinking was identified, with only 16.4% of respondents intervening when pregnant women reported at-risk alcohol consumption. ConclusionContinued efforts are needed to improve alcohol screening practices among womens HCPs across Canada. Priority areas for training include: understanding validated alcohol screening questionnaires; incorporating brief intervention into routine care; and developing local referral pathways.

BackgroundOvarian cancer is a leading cause of gynecologic cancer-related mortality. While most cases arise as a primary malignancy, a subset occurs as a second primary cancer following a previous non-ovarian malignancy. Limited studies have examined the survival differences between these groups. ObjectiveTo compare the characteristics, treatment patterns, and survival outcomes of women with primary ovarian cancer versus second primary ovarian cancer and identify factors associated with cancer-specific survival (CSS) and overall survival (OS). MethodsThis retrospective cohort study utilized data from the Surveillance, Epidemiology, and End Results (SEER) 18 Registry (2000-2021). Women aged [&ge;]18 years diagnosed with primary or second primary ovarian cancer were included. Multivariable Cox proportional hazards models estimated the association between primary cancer status and survival outcomes, adjusting for demographic, tumor, and treatment-related factors. ResultsA total of 27,308 women were included: 23,132 (84.7%) with primary ovarian cancer and 4,176 (15.3%) with second primary ovarian cancer. Women with second primary ovarian malignancies were older (44.6% vs. 35.6% >64 years, p<0.001) and more likely to be White (71.3% vs. 66.0%, p<0.001). They were diagnosed more frequently at earlier stages (Stage I: 35.4% vs. 32.4%, p<0.001). Women with second primary ovarian cancer had significantly better CSS at 5 years (60.3% vs. 56.8%, p<0.001) and 20 years (43.5% vs. 39.1%, p<0.001). After adjustment, they had a 7.2% lower risk of cancer-specific mortality (HR: 0.928, 95% CI: 0.876-0.982, p=0.010). However, OS was similar at 5 years (53.0% vs. 53.5%, p<0.001), with a survival disadvantage emerging over time (HR: 1.057, 95% CI: 1.005-1.113, p=0.031). ConclusionWomen with second primary ovarian cancer had better CSS than those with primary ovarian cancer, likely due to earlier detection and increased surveillance. However, long-term OS disparities suggest a need for continued optimization of follow-up care and management strategies.

ObjectiveDetermine whether hormone-associated venous thromboembolism (VTE) risk varies by exposure route and formulation in 50-64 year-old US women. DesignNested case-control study. SettingLarge US commercially-insured population with patient-level claims data. ParticipantsWomen aged 50-64 years with at least one year of enrollment. Controls were matched to incident cases (10:1) on VTE date and cases age (+/- 2yrs). Exclusions included prior VTE, intravascular vena cava (IVC) filter within twelve months, and anticoagulant exposure within 14 days. ExposuresAll estrogen and progestogen prescriptions (with route and formulation) filled within 12 months prior to index date were coded as current (0-60 days), past (61-365 days), or none. Contraceptives were categorized separately. OutcomeAcute VTE cases were identified with ICD codes plus anticoagulant, IVC filter, or death within 30 days. ResultsConditional logic regression analyses controlled for differences between cases (n=20,359) and controls (n=203,590) in Elixhauser comorbidities and VTE risk factors. Odds ratios (OR) were as follows: for current oral, unopposed estradiol 1.24 (95% CI: 1.09 to 1.40) or conjugated equine estrogen (CEE) 1.46 (95% CI: 1.28 to 1.68); for progestogens with estradiol 1.14 (95% CI: 0.95 to 1.37), with CEE 1.52 (95% CI: 1.25 to 1.84), or with ethinyl estradiol 2.35 (95% CI: 1.71 to 3.25). Current transdermal estradiol had the lowest ORs, whether unopposed, 0.70 (95% CI: 0.59 to 0.83) or combined with progestogens, 0.73 (95% CI: 0.56 to 0.96), but varied by progestogen. The OR for estrogen-progestogen contraceptives was 5.22 (95% CI: 4.67 to 5.84) compared to no exposure and 4.24 (95% CI: 3.64 to 4.98) compared to combined MHT. ConclusionsIn 50-64-year-old women, transdermal menopausal hormone therapy (estradiol with or without progestogens) did not elevate VTE risk. In contrast, contraceptives markedly increased VTE risk. Summary Boxes What is already known on this topic?O_LIRandomized controlled trials indicate that relative risk for venous thromboembolism (VTE) is approximately twice as high with menopausal hormone therapy (MHT) containing conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate compared to no hormone exposure. C_LIO_LIRecent large, observational studies in the UK and Europe suggest that estradiol is lower risk than CEE and transdermal estradiol does not raise VTE risk compared to no hormone exposure, but results may not generalize to the United States because of differences in formulary, prescribing patterns, and background VTE incidence. C_LI What this study addsO_LIUsing a large medical record database for US commercially-insured women 50-64 years of age, results confirmed that VTE risk was higher for oral compared to transdermal MHT and transdermal MHT (unopposed estrogen or combined with a progestogen) did not increase risk for VTE compared to no hormone exposure. However, unique US prescribing patterns included MHT with transdermal estradiol plus oral progestogens and MHT with ethinyl estradiol. C_LIO_LIMHT estrogen formulation affected VTE risk: ethinyl estradiol had higher risk than CEE, and CEE had higher risk than estradiol. C_LIO_LICombined hormonal contraceptives (oral, vaginal, transdermal) had a markedly higher increase in VTE compared to MHT. C_LI

The use of self-sampling devices in population-based cervical cancer screening programmes (CCSP) is both an opportunity and a challenge in terms of implementation. ObjectiveTo understand the expectations, preferences, and difficulties perceived by women as regards different screening models and self-sampling devices, with the aim of identifying strategies to achieve high CCSP participation rates. MethodsThis study is based on qualitative research techniques, consisting of an individual interview using a questionnaire with semi-structured questions, followed by a group interview. Sessions were held simultaneously with 4 groups (7-8 women aged between 35 and 65). Women assessed various aspects of the programme (information dissemination, invitation, receipt of results, etc.) and five self-sampling devices. ResultsIf screening were carried out via self-sampling, 96.4% of women said they would take the test. Most women preferred to receive information on the CCSP or return their samples at their health centres (86.2% and 86.2%), and the most popular method for receiving both the programme invitation and results is by SMS (58.6%, 65.5%). Simplicity and ease of use are the key features of the device accepted by the largest number of women, the FLOQSwab. Another highly rated feature is the attractive design of the Evalyn Brush, as this was the preferred device of the largest number of women. The existence of other screening programmes that use self-sampling devices (the colorectal cancer prevention programme) is an opportunity as regards acceptance of this new programme. Some women are unsure of how to use the devices correctly. A large number of women accept self-sampling and reveals significant differences in the degree of acceptance of different self-sampling devices. Selecting the most accepted device is key to achieving high CCSP participation rates, and these programmes should be accompanied by adapted information campaigns to reach the most vulnerable groups and ensure equity.

BackgroundMultiple barriers limit access to traditional in-person clinician sampling for cervical cancer. The STAMP (Screening with Tampons: Evaluating Diagnostic Accuracy for HPV and Assessing Participant Views) study evaluated the diagnostic accuracy and acceptability of tampon-based self-sampling for HPV amongst people assigned female at birth. Encouraging technical performance of the tampon as a sample for microbial detection was observed relative to clinician-taken samples. Pre and post trial questionnaires and a nested qualitative study explored acceptability. MethodsAll participants (n=263) completed questionnaires before and after sampling using three methods: tampon-based self-sampling, swab-based self-sampling, and clinician-collected samples. Questions included comfort, trust and ease of use of tampon-sampling. Four focus groups (n=24) were conducted online, and analysed using reflexive thematic analysis. ResultsQuestionnaire responses suggested tampon-based self-sampling was highly acceptable. Qualitative analysis identified four key themes: advantages of self-sampling over clinician-sampling; unique benefits of tampon-based self-sampling; concerns about accuracy and trust; and confidence in correct use. Participants valued the physical comfort, psychological ease, and practical convenience of self-sampling compared to clinician-sampling. The familiarity of tampons as an everyday product was central to acceptability, normalising screening. While some initially questioned accuracy, most were reassured by evidence of performance. Clear instructions and understanding the evidence base boosted confidence. ConclusionFindings suggest that tampon-based self-sampling is a highly acceptable alternative sampling approach for cervical screening that may increase screening participation by addressing multiple barriers. Implementation strategies should emphasise the methods everyday nature, while providing accessible guidance to support correct usage. What is already known on this topicO_LISelf-sampling for Human Papillomavirus (HPV) has been recommended by the World Health Organisation as an additional approach to expand cervical cancer screening services, complementing conventional clinician-taken sampling to broaden access and address barriers associated with in-person care. C_LI What this study addsO_LIFindings from this study suggest that self-sampling has the potential to support screening for cervical cancer as an acceptable, at-home approach addressing physical, psychological and practical barriers associated with traditional clinician collected sampling. C_LIO_LIParticipants reported that the familiarity of using a tampon for self-sampling creates a unique advantage over other self-sampling methods through demedicalising and normalising screening, therefore potentially increasing accessibility and participation among underscreened populations who experience most barriers. C_LI How this study might affect research, practice or policyO_LISelf-sampling including tampon-based self sampling offers a promising, acceptable approach to achieving cancer elimination goals. C_LIO_LIImplementation of tampon-based self-sampling for HPV should be clear, comprehensive and accessible, incorporating visual aids and simple language while emphasising the rationale and scientific evidence behind the collection method C_LI

In June 2022, the U.S. Supreme Court overturned Roe v Wade. Half of states now face proposed or in-effect abortion bans, which affect the ability of obstetrics and gynecology (ObGyn) residency programs to provide abortion training. Prior to the Supreme Court decision, we surveyed ObGyn residents at all four programs in Wisconsin and Minnesota to assess residents attitudes toward abortion, desire to learn about abortion, and intentions about providing abortion care in their future practice. We found that participants overwhelmingly support abortion, find the issue to be important, and plan to incorporate abortion into future practice. The reversal of Roe v Wade and its impact on access to abortion training may have implications for ObGyn residency recruitment and training, related career decision-making, and future workforce.

BackgroundDescriptive study of Japanese sexual and gender minority (SGM) population with national representativeness have not been conducted. We sought to estimate the proportion of the Japanese SGM, and to describe those demographic, socioeconomic, and health-related variables. MethodsUtilizing data on a nationwide cross-sectional internet survey from September 12th to October 19th, 2022, we conducted a comprehensive descriptive study by applying inverse probable weighting method for national representativeness. Participants self-reported as heterosexual, homosexual, bisexual, or gender minority (GM) and responded to questions on various demographic, socioeconomic, and health-related concerns. FindingsAmong Japanese adults, 4.8% identified as homosexuals, 1.3% as bisexuals, and 3.8% as GMs. SGMs were less likely to be married/partnered compared to heterosexuals, though a certain proportion were in opposite-sex marriages/partnerships. SGMs had lower household equivalent income, insurance coverage, home ownership, current smoking rates, good self-rated health, and full COVID-19 vaccination rates. They also exhibited higher rates of substance use, severe psychological distress, feelings of loneliness, and fear of COVID-19 compared to heterosexuals. When divided by assigned sex at birth, SGM males had poorer employment status, lower academic attainment, and higher body mass index compared to their heterosexual counterparts, while SGM females showed opposite trends. InterpretationDifferences in demographic, socioeconomic, and health status between heterosexuals and SGMs underscore the need for targeted health policies and interventions to address health disparities among Japanese SGMs. Additionally, these results suggest that directly applying Western health policies to the Japanese context may not always be appropriate. FundingFunded by the Japan Society for the Promotion of Science, the Research Support Program to Apply the Wisdom of the University to tackle COVID-19 Related Emergency Problems, University of Tsukuba, and Health Labour Sciences Research Grantand the Japan Agency for Medical Research and Development.

BackgroundAspirin use for cardiovascular indications is widespread despite evidence not supporting use in patients without cardiovascular disease (CVD). This study characterises aspirin prescribing among people aged [&ge;]50 years in Ireland for primary and secondary prevention, and factors associated with prescription. MethodsThis cross-sectional study includes participants from wave 3 (2014-2015) of The Irish Longitudinal Study on Ageing. We identified participants reporting use of prescribed aspirin, other antiplatelets/anticoagulants, and doctor-diagnosed CVD (MI, angina, stroke, TIA) and other cardiovascular conditions. We examined factors associated with aspirin use for primary and secondary prevention in multivariate regression. For a subset, we also examined 10-year cardiovascular risk (using the Framingham general risk score) as a predictor of aspirin use. ResultsAmong 6,618 participants, the mean age was 66.9 years (SD 9.4) and 55.6% (3,679) were female. Prescribed aspirin was reported by 1,432 participants (21.6%), and 77.6% of aspirin users had no previous CVD. Among participants with previous CVD, 17% were not prescribed aspirin/another antithrombotic. This equates to 201,000 older adults nationally using aspirin for primary prevention, and 16,000 with previous CVD not prescribed an antithrombotic. Among those without CVD, older age, male sex, free health care, and more GP visits were associated with aspirin prescribing. Cardiovascular risk was significantly associated with aspirin use (adjusted relative risk 1.15, 95%CI 1.08-1.23, per 1% increase in cardiovascular risk). ConclusionAlmost four-fifths of people aged [&ge;]50 years on aspirin have no previous CVD, equivalent to 201,000 adults nationally, however prescribing appears rational in targeting higher cardiovascular risk patients.

Background: Smoking impairs lung immune functions and damages upper airways, increasing risks of contracting and severity of infectious diseases. Methods: We searched PubMed and Embase for studies published from January 1-May 25, 2020. We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death. We used a random effects meta-analysis and used meta-regression and lowess regressions to examine relationships in the data. Results: We identified 47 peer-reviewed papers with a total of 31,871 COVID-19 patients, 5,759 (18.1%) experienced disease progression and 5,734 (18.0%) with a history of smoking. Among smokers, 29.2% experienced disease progression, compared with 21.1% of non-smokers. The meta-analysis confirmed an association between smoking and COVID-19 progression (OR 1.56, 95% CI 1.32-1.83, p=0.001). Smoking was associated with increased risk of death from COVID-19 (OR 1.19, 95% CI 1.05-1.34, p=0.007). We found no significant difference (p=0.432) between the effects of smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression. We also found the risk of having COVID-19 progression among younger adults (p=0.023), with the effect most pronounced among people under about 45 years old. Conclusions: Smoking is an independent risk for having severe progression of COVID-19, including mortality. The effects seem to be higher among young people. Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic.

BackgroundConcerns regarding the effects of non-tampon menstrual products on reproductive and urogenital health, particularly the risk of infections, is an area of ongoing investigation. We conducted an updated systematic review to assess methodological quality of the current evidence assessing associations between menstrual product use and reproductive and urogenital infections (RUTIs), and offer recommendations for future research. MethodsThree databases (PubMed, Web of Science, United States Food and Drug Administration Manufacturer User Facility Device Experience) were searched for relevant published studies or product safety reports up to October 13, 2024. We included studies on menstruators of any age and geography assessing for any reusable/disposable menstrual pads, menstrual cups, or homemade alternatives worn only for menstrual absorbency compared to other menstrual products or no product use, with outcomes centered on RUTIs. Protocols, reviews, and studies assessing only tampons or non-menstrual absorbents were excluded. Results were evaluated and synthesized using tabular methods according to measures of association, and across four criteria categories 1) product definition, 2) comparator definition, 3) outcome definition, and 4) confounder consideration. ResultsThirty-one studies were included in this review. Most studies clearly defined outcomes and considered necessary confounders. In contrast, studies with well-defined products (6.5%) and comparator products (9.7%) were uncommon. Ten studies (32.2%) reported some data on four or more confounders, and seventeen (54.8%) defined their infectious outcomes and included laboratory confirmation. A meta-analysis was not possible due to data heterogeneity across product, comparator, and outcome definitions. Overall, associations between menstrual products and RUTIs are inconclusive. ConclusionFuture studies should 1) clearly define product and comparator type, material, frequency of change, and washing, drying, and storage practices for reusable products, 2) prioritize laboratory or clinician-confirmed outcomes over self-reported symptoms, and 3) adjust for relevant confounders.

Early reports raised concern that use of non-steroidal anti-inflammatory drugs (NSAIDs) may increase risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19). Users of the COVID Symptom Study smartphone application reported use of aspirin and other NSAIDs between March 24 and May 8, 2020. Users were queried daily about symptoms, COVID-19 testing, and healthcare seeking behavior. Cox proportional hazards regression was used to determine the risk of COVID-19 among according to aspirin or non-aspirin NSAID users. Among 2,736,091 individuals in the U.S., U.K., and Sweden, we documented 8,966 incident reports of a positive COVID-19 test over 60,817,043 person-days of follow-up. Compared to non-users and after stratifying by age, sex, country, day of study entry, and race/ethnicity, non-aspirin NSAID use was associated with a modest risk for testing COVID-19 positive (HR 1.23 [1.09, 1.32]), but no significant association was observed among aspirin users (HR 1.13 [0.92, 1.38]). After adjustment for lifestyle factors, comorbidities and baseline symptoms, any NSAID use was not associated with risk (HR 1.02 [0.94, 1.10]). Results were similar for those seeking healthcare for COVID-19 and were not substantially different according to lifestyle and sociodemographic factors or after accounting for propensity to receive testing. Our results do not support an association of NSAID use, including aspirin, with COVID-19 infection. Previous reports of a potential association may be due to higher rates of comorbidities or use of NSAIDs to treat symptoms associated with COVID-19. One Sentence SummaryNSAID use is not associated with COVID-19 risk.

BackgroundAlmost every medical professional organization supports abortion access. Meanwhile, federal and state-level policies continue to erode abortion-related healthcare. Physicians are instrumental to abortion access, and their evidence-based attitudes could significantly influence public understanding. However, most studies of physician attitudes about abortion focus on specific subgroups. A study of abortion attitudes among a broader population of clinicians is important for at least three reasons. First, results could provide insights and strategies to improve access and reduce stigma at academic medical centers and beyond. Second, findings could explain discrepancies between expressions of support for abortion by the medical community and the inability or unwillingness of the same community to provide sufficient access to abortion services. Third, gauging the climate of opinion among physicians in a politically contested state is likely to be informative given that most abortion-related judicial decisions will occur in state-versus federal-level courts, and physician attitudes could potentially influence public policy. ObjectiveTo use leading survey methodologies to assess abortion-related attitudes among all physicians at the largest academic medical center in a politically contested Midwestern state. Study DesignInvestigators developed a cross-sectional survey to gauge abortion-related knowledge, attitudes, and practices. The universitys survey research center disseminated the survey to all 1,357 physician faculty members of the school of medicine and public health using a web and mail mixed-mode methodology (67% response rate). Analyses included chi-squared tests and binary logistic regression models of support for abortion procedures and willingness to consult in abortion care. ResultsAcross more than 20 specialties and all sociodemographic categories, physicians reported strong support for abortion. Majorities expressed support for medication (81%) and surgical abortion (80%), that abortion should be legal in all or most cases (88%), and that a state law banning abortion would make womens health worse (91%). While nearly all physicians (94%) care for women of reproductive age, most (69%) reported no opportunity to participate in abortion care and fewer than half (44%) knew whom to contact to refer a patient for abortion care. Female physicians and those who considered their expertise relevant to abortion were more supportive, while physicians of color and highly religious physicians were less supportive. Few physicians reported participating in any aspect of abortion care (14%), though nearly two-thirds were willing to consult in such care (65%). Those with relevant expertise were more willing to consult, while physicians of color and highly religious physicians were less willing. While most physicians said they support unrestricted access to abortion (63%) and the efforts of abortion providers (70%) "a lot," a majority perceived relatively less support among their professional peers, revealing a climate of pluralistic ignorance. ConclusionsDespite overwhelming support for abortion among this population, participation in any aspect of abortion care is remarkably low. Physicians across all disciplines need clear training and guidelines on how to refer patients for abortion care, and abortion should be normalized and integrated into mainstream medicine. Given professional organizations support of abortion and physicians cultural influence, these results can be used to inform public policy regarding abortion access.

ObjectiveThe increased stress the globe has experienced with the COVID-19 pandemic has affected mental health, disproportionately affecting women. However, how perceived stress in the first year affected menstrual and menopausal symptoms has not yet been investigated. MethodsResidents in British Columbia, Canada, were surveyed online as part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE). A subgroup (n=4171) who were assigned female sex at birth (age 25-69) and were surveyed within the first 6-12 months of the pandemic (August 2020-February 2021), prior to the widespread rollout of vaccines, were retrospectively asked if they noticed changes in their menstrual or menopausal symptoms, as well as completing validated measures of stress, depression, and anxiety. ResultsWe found that 27.8% reported menstrual cycle disturbances and 6.7% reported increased menopause symptoms. Those who scored higher on perceived stress, depression, and anxiety scales were more likely to have reproductive cycle disturbances. Free text responses revealed that reasons for disturbances were perceived to be related to the pandemic. ConclusionsThe COVID-19 pandemic has highlighted the need to research womens health issues, such as menstruation. Our data indicates that in the first year of the pandemic, almost a third of the menstruating population reported disturbances in their cycle, which is approximately two times higher than in non-pandemic situations and four times higher than any reported changes in menopausal symptoms across that first year of the pandemic. Summary SentencesWomen+ with higher anxiety, depression or perceived stress scores during the first year of the pandemic were more likely to have experienced menstrual cycle phase disturbance or menopausal status disruption. Younger women were particularly prone to disturbances in their reproductive cycles.